NPIMap

Organization Active NPI

Northland Dental LTD.

  • Dental Clinic/Center
  • Moorhead, MN
National Provider Identifier
1972873156
Registry record updated Jan 5, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dental Clinic/CenterTaxonomy code 261QD0000X
License
MN 9657 Issued in MN
Legal business name
NORTHLAND DENTAL LTD.
Practice address
2121 Highway 10 E
Moorhead, MN 56560-2559
Phone
(218) 236-7076
Fax
(218) 236-4999
NPI assigned
Jan 5, 2012
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 5, 2012

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Tom G Anderson, DDS
Title
Owner Dentist
Phone
(218) 236-7076

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dental Clinic/Center 261QD0000X MN 9657 MN Primary
Dental Clinic/Center 261QD0000X D12404 MN

Addresses

Primary practice location

2121 Highway 10 E
Moorhead, MN 56560-2559

Mailing address

2121 Highway 10 E
Moorhead, MN 56560-2559
Phone (218) 236-7076

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1325721600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1325721600000",
    "number": "1972873156",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2121 HIGHWAY 10 E",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602559",
            "telephone_number": "218-236-7076",
            "fax_number": "218-236-4999"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2121 HIGHWAY 10 E",
            "city": "MOORHEAD",
            "state": "MN",
            "postal_code": "565602559",
            "telephone_number": "218-236-7076",
            "fax_number": "218-236-4999"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "NORTHLAND DENTAL LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2012-01-05",
        "last_updated": "2012-01-05",
        "status": "A",
        "authorized_official_last_name": "ANDERSON",
        "authorized_official_first_name": "TOM",
        "authorized_official_middle_name": "G",
        "authorized_official_title_or_position": "OWNER DENTIST",
        "authorized_official_telephone_number": "218-236-7076",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS"
    },
    "taxonomies": [
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "MN 9657",
            "primary": true
        },
        {
            "code": "261QD0000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Dental",
            "state": "MN",
            "license": "D12404",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Moorhead, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 5, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.